Provider Demographics
NPI:1023739927
Name:BANDY, WILLIAM LAKE (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAKE
Last Name:BANDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491653
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1653
Mailing Address - Country:US
Mailing Address - Phone:352-728-6636
Mailing Address - Fax:
Practice Address - Street 1:340 HEALD WAY STE 232
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6088
Practice Address - Country:US
Practice Address - Phone:352-330-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist